Ground Transportation
Account Cancellation Request
Company Name:
Address:
City, State Zip
TCP or PSC #:
Phone:
JWA Account #
(
)
Cancellation
-
Phone: (
(if applicable, insert name)
(Please circle one)
/
Effective Date:
Sold Company To:
Security Deposit
GT-0000
Transfer to the new company?
YES
/
)
/
NO
-
/
NA
I, the undersigned, certify that all the information provided on this form is true and correct. I also
certify that my company (listed above) will no longer be operating and/or doing business at the John
Wayne Airport.
Please close my account and return my security deposit to the address listed above unless otherwise
noted. I, the undersigned, understand that in order to start working at JWA again, I will need to resubmit a new permit package.
Owner Signature
Date
Owner Name (Please Print)
Owner
Title
Please deliver this form to:
John Wayne Airport/Landside Administration
18601 Airport Way, Box 41, Ste 116
Santa Ana, CA 92707
Attention: Kathy Davis
Fax: (949) 252-5243
or
Email: [email protected]